Medicalization of Society: is everyone out there sick?

   Sometimes I wonder, is everybody out there sick?  Now, that may seem a strange question coming from someone who has made his living out of treating sick people and teaching others how to look after sick people.  However, I think I can count the number of times my siblings and I saw a doctor in our childhood and adolescence.  I don't believe it was because we were healthier than kids are today, I think it was because most parents could determine when their healthy kid with a cold was becoming a sick kid and needed something more than the home remedies that worked most of the time.  They recognized that a healthy kid with a stuffy nose or a mild sore throat was a healthy kid with a 'normal' affliction and they were usually right.  They were sufficiently confident in dealing with these minor disorders to recognize that their natural history was that they subsided within a few days.  Most of the time they did, but if they didn't then they wanted expert advice, then they called the doctor.  An old fashioned family doctor, which is what I was, knew most of his families and when a mother phoned up to see if she needed to bring the kid in, or if the doctor needed to make a home visit, the answer was usually apparent.  Often all that was needed was a word of advice, but sometimes the kid needed to be seen,  Those were the days when a patient could actually get to talk to the doc on the phone and when the patient needed to be seen the doc saw the patient, he or his staff didn't send the patient to the ER.  That was also in the days before the industrialization of medicine and before walk-in clinics and before it was considered quite normal to bring the child with 104 degrees temp to the emergency room, to crowd in with a couple of dozen patients all sneezing and coughing and dispersing their germs. Pretending that all the danger was neutralized by a little germicidal hand gel and occasionally a paper mask.  Unfortunately, along with the industrialization of medicine came the medicalization of society, that vital piece of social engineering that is necessary to make the industrialization work.  After all, if there are not enough labelled sick people around how are the Health Care Czars and their administridiots going to justify their outrageous salaries and bonuses.  New diagnoses, mental and physical have had to be generated to produce figures to make it look as though all of the population are in constant need of those services that so successfully win votes.  I am not proud of the role my own profession played in this.
   Turn on your television any mealtime and you will see that we are all ill.  Indigestion, stomach discomfort, constipation, diarrhea, low testosterone, lack of libido, incontinence (indeed, you are offered an amazing variety of catheters of all sizes, shapes and colours, more than on the urology wards!) and a myriad of other complaints that were once considered the minor disorders that normal healthy people deal with.  You are offered medications for your heart, lungs, joints, brain and any discomfort they can think of.   You are informed that no discomfort is acceptable and that there is a pill for everything.  You are told about their side effects by smiling actors walking through green meadows, including the occasional sudden death!   Once the entire popularization is diagnosed, labelled and on the appropriate medication, the government will decide what merits treatment and will be able to cherry-pick appropriate measurements  on  the basis of  cost and votes garnered.  Assisted suicide and legalized drugs will  be popular ways to keep some quiet or at least happy.  Most physicians  will be financially bullied into going along, and don't have what it takes to set medicine on the right course again, though I note that these days the women in medicine seem to have more balls.  Our pathetic professional organizations do little to  ameliorate the  situation.
    The decline continues. 

The High Cost of Health Care.

 

"In 2015, the estimated average payment for public health care insurance ranges from $3,789 to $12,055 for six common Canadian family types, depending on the type of family.
For the average Canadian family, between 2005 and 2015, the cost of public health care insurance increased 1.6 times faster than average income, 1.3 times as fast as the cost of shelter, and 2.7 times as fast as food."

- See more at: http://www.fraserinstitute.org/studies/price-public-health-care-insurance-2015-edition#sthash.kIQn37GP.dpuf

In 2015, the estimated average payment for public health care insurance ranges from $3,789 to $12,055 for six common Canadian family types, depending on the type of family.
For the average Canadian family, between 2005 and 2015, the cost of public health care insurance increased 1.6 times faster than average income, 1.3 times as fast as the cost of shelter, and 2.7 times as fast as food.
- See more at: http://www.fraserinstitute.org/studies/price-public-health-care-insurance-2015-edition#sthash.kIQn37GP.dpuf

In 2015, the estimated average payment for public health care insurance ranges from $3,789 to $12,055 for six common Canadian family types, depending on the type of family.
For the average Canadian family, between 2005 and 2015, the cost of public health care insurance increased 1.6 times faster than average income, 1.3 times as fast as the cost of shelter, and 2.7 times as fast as food.
- See more at: http://www.fraserinstitute.org/studies/price-public-health-care-insurance-2015-edition#sthash.kIQn37GP.dpuf

  I have no doubt at all that the high cost of Health Care could consume the entire national budget.  Much  as we love the  concept of everything related to the promotion of health being entirely paid for by the state (taxpayer), commonsense and a little basic math make it clear that this is not and cannot be possible in the long term.  As the population continues to age and people grow older and sicker, requiring more sophisticated and more expensive care, the diminishing  number of young  healthy adults that have always formed the base of the social pyramid that finances the system gets smaller.  The concept of a 'free' health care system is, of course a deliberate political device to fool the populace into thinking the Government is providing them with something for nothing, rather than confiscating their money and dispersing it in  the way that they deem most appropriate.  If you believe that the government can use your money more effectively than you can manage it yourself, then you have the ideal, or almost ideal  system, until the money runs out or the young to middle aged feel over-burdened to the extent that they are prepared to rebel.    If you believe that is the best we can do then you have a responsibility to see that your elected representatives are acting in  your best interests and are accepting the exact same level of care as you do.  (If you think that is the case at present, you are a little naive).   Clearly, they are not doing the best that can be done and unfortunately public reaction  is largely  indifference unless one is unfortunate enough to get caught up  in the morass that the generally poorly  informed administridiots devise to keep the system limping along until  after the next election.  It frequently seems to limp along sufficiently well for the patient to  get acceptable care, mainly riding on  the backs of the health care workers who still care and work  hard to make the system work.  Unfortunately,even the most dedicated find things are wearing thin when a government that is asking them to work harder and longer hours  than most civil servants can even imagine, is at the same time cutting physicians fee schedule by almost five per cent.  Nurses also are feeling the pinch, while the administridiots award themselves what in many cases are obscene salaries and even bonuses. (Go figure!)   As far as I can tell, restraints seem rarely to effect the administrative layer, who feel they should have salaries at least comparable with the most successful in industry.  That is the reason that the health care system has been transformed into the health care industry.  That attitude is so pervasive that it it is finally infiltrating the infrastructure of the health system, the doctors and nurses.  Physicians are no longer prepared to work around the clock, often on a pro bono basis, as they once were.  There are many reasons for this but physician burnout is another huge topic for another day.   Suffice it to say, that the idealism that carried generations of physicians through a difficult but rewarding career has withered on the vine.  Medical residents have a union so powerful that it would have been both unimaginable, unacceptable and unprofessional in my student and resident days.   The idealistic, committed medical professionals of yesteryear and beyond are being replaced by a cadre of civil service medical technician.  They will demand and they will get all the benefits of being civil servants and will behave accordingly.  All it will cost them is their freedom, their independence and their medical 'souls'
     I am afraid it will cost patients a great deal more, fortunately they will never know how much. 

Every patient needs an advocate in the Health Care Industry.

              When we walked into North York General Hospital our initial  impression was it looked bright and cheerful. The lobby was dressed up really nicely and it had a really impressive gift shop.  My daughter's partner had been admitted two days earlier and had emergency surgery for a bowel obstruction.    I spoke to my daughter (a nurse) the night before and she informed me he was doing well and was already being walked around.  (Seemed a bit early to me, but what would an antiquated old gp know? )
              By the time we got up to the surgical ward the surroundings looked a little less luxurious, in fact one might say a little on the seedy side and the patient was sitting up in bed, cold and clammy,looking rather 'shocky'.  (as though he was about to faint.)  We laid him down flat and called the harassed nurse who was busy trying to get another patient en route to the operating room.    Meanwhile my daughter put a hand on his abdomen and called me over to do the same.  His bowel was grossly distended and he had been given some sort of suppository to accomplish God knows what.   The gastric suction did not appear to be functioning adequately.  Following all of this and I must emphasize that we were pleasant, polite and understanding, we were starting to attract just a little bit of notice.  Unfortunately, that sometimes seems to be necessary to make things happen. My daughter wanted to talk to the doctor or resident and shortly thereafter a bowel x-ray was being arranged.  She cancelled other plans she had and decided that she better stick around and look  after him.
              Now,I am not blaming any of the care givers, but there is something seriously wrong with a system that could allow a post surgery patient to slip into shock in an acute care hospital.
               Not every patient has an advocate in the health care professions, but every seriously ill patient needs an advocate with the patient's welfare at heart,especially when the patient is too ill do so so for himself.    Not to tell the health professionals what to do, but to show  there is someone who cares for the patient as a human being and to provide the care that the often overworked and harassed members of that profession can no longer look after in the Health Care Industry.
              Tell me if you think your family member would need a medical advocate. 
              
                 
                

For Sale: Fetal Parts (freshly butchered).

      The intrauterine decimation, decapitation,destruction and  other means of dehumanization of the unborn human baby is so horrible that it  is reminiscent of the savagery and inhumanity of the Third Reich.  It is truly a symptom of decline and fall.  Particularly horrifying is the manner in which some physicians of the 'Planned Parenthood' coven discuss these issues in the callous and indifferent manner we have heard  recently, as though the lives they are extinguishing are meaningless pieces of protoplasm.  Unfortunately, 'Planned Parenthood' is often a euphemism for  planned infanticide.  Here we are not primarily talking about abortions that have any medical indication at all, not young girls who were impregnated, not women who were raped or distressed by some other circumstance that led to their  pregnancy.  Frequently, we are referring to abortion as a form of  birth control, a convenience.  The 'Planned Parenthood ' group see this as right and receive federal funding, forcing the taxpayer to support their barbaric practices.  In fact, they are so comfortable with it they are devising methods that do not destroy the baby's organs so they can be sold for good hard cash.  They are, in effect, bargaining over the price of dead baby parts.  Hard to get much more barbaric than that..  I thought there were laws prohibiting such practices. Some doctors, apparently see this as right too.  The principals of  modern medicine  have changed.  I can  no longer unreservedly recommend medicine as a career to the thoughtful and principled young people who sometimes ask me about it.  The demands of a significant portion of the population want medicine to be something other than  a humane healing art, something to satisfy  their immediate needs or desires and that  is changing a profession I  have dedicated my life to into something else.  Technology, as wonderful as it is, is far from being the be-all, end- all, of what medicine is about.   The politicians are pleased to grant these wishes in the hope of garnering votes. The control of medicine by administridiots, bureaucrats and politicians is accelerating the decline of medicine into what is called the  Health Care Industry.  Not a step in the right direction.
                Comment if you dare!

Where ignorance is bliss.

         The University of Manitoba recently had its commencements lecture to medical graduates presented by a journalist who specializes in health care.  His name is Andre Picard.   Picard is unfortunately a sanctimonious hack with little understanding of the health care system despite the thirty years he proudly informs us of reporting in that area.  He bemoans the poor communication between physicians and patients and presumes in the course of a brief presentation to teach these young graduates the right way to practice the art of medicine.   I have spent forty years teaching family medicine residents the art of medicine as well as the science.  I taught them the 'conversation' between physician and patient is vital, that house calls are an important tool, that there are limitations to investigation and treatment before the patient is harmed rather than helped.   Some learn quickly but time constraints are serious and limiting when it comes to applying what they have learnt.  The fee schedule doesn't help either.  The reward for freezing a plantar was more than for a half hour consultation for depression.  Picard doesn't understand that the unfortunate direction of medical care is the result of political decision making and the administridiots who serve them.  He has bought in to the theory that well paid administrators  perpetuate to protect their jobs, that they are the 'experts' in health care and how it should be delivered.   They only understand the 'Health Care Industry,' which has to do  with votes and finances.  Physicians have been manipulated, directed, bribed, threatened and penalized to make health care into what the politicians and their satraps want it to be and the experience and expertise of lifetime practitioners is cast aside. Unfortunately, it is the public who will pay the price for these ill-conceived notions.
        Many of the finest and most dedicated hardworking physicians I know have become so disillusioned with the direction in which medical practice is moving that they look forward to early retirement.
        Finally, our paymasters decided the value of house-calls, an important aspect of medical care, and a great convenience to the genuinely sick and elderly, when they decided they were worth about half the cost of a plumber's visit.

The Annual Physical Examination

              "I would argue that we should move forward with the elimination of the annual physical," says Dr. Ateev Mehrotra, a primary care physician and a professor of health policy at Harvard Medical School.

                I absolutely disagree with him!   The 'complete history and physical examination' was the foundation of the relationship between patient and physician, when I was a medical student and for hundreds of years before.  One could debate the optimal frequency and whether it needs to be annual and that depends on the patients age and other factors.   The Health Care Industry wants to change all that and is succeeding.   The general objective seems to be to weaken and ultimately undermine the physician patient relationship that results when a patient has built up a lifelong relationship with a doctor.  That relationship plays an important role in the healing process and is unlike any business or industrial relationship.   It is an essential ingredient of medical professionalism.  The last thing the health care administrators want is a relationship between doctors and patients that undermine their ability to engineer the health care system to fit their ideal model.  Bearing in mind that many of these administrators come from a financial background, it is not peculiar that cost is a major preoccupation.  And so  it should be, it is the manner in which they try to manipulate the changes that is destructive.     Ignorant of medicine and anxious to please their political masters, they try to effect savings without costing votes.  That is hard to do unless one can make it appear that a lot of the expenses incurred are wasteful and unnecessary.    They certainly don't want to cut back on any dramatic newsworthy procedures but if they can cut back on demand for perceptually minor, less newsworthy  services perhaps they can eat their cake and have it too.   So, the Choose Wisely Program (and who wouldn't want to choose wisely?) was born.   The doctor and patient would collaborate and decide what tests should be done, by mutual consent and (implicitly) do much less testing.     Nowadays, with universal internet access, patients often come in with reams of printouts that they'd like to discuss.   Doctors, with ten or fifteen minute appointments, struggling to meet the additional time requirements of their relatively recently introduced time consuming electronic medical records, are going to see fewer patients.  

            But let's get back to the annual history and physical examination.   I believe it to be one of the most relevant exchanges in health care, ancient or modern.  The conversation between patient and doctor is the essential exchange that is the initiating point for most medical care.   Conversation, the informal exchange of thoughts and information by spoken words; oral communication between people.   It is at the annual health examination that the doctor and  the patient get to know  each other.  The patient doesn't have to be sick for a valuable and meaningful exchange to take place.   For years we have idealized preventative medicine, the wellness model, total health care etc. etc. and while we sometimes have gone overboard, let's not throw out the baby with the bathwater, largely under the mistaken impression that it will make health care less expensive.   The  history, physical and screening procedures developed over the years have sometimes been excessive, but have played no small part in the improved health status that most Canadians enjoy.  The  educational opportunities that have been a part of that process have paid off big time.  Don't let any administridiot convince you otherwise.   I can assure you they won't be giving up their periodic health assessments.  

              In the course of the annual health examination one comes across a significant number of unsuspected morbidities, physical and psychological, diabetes, cardiac conditions from murmurs to atrial fibrillation, malignant skin lesions, cervical carcinomas. osteoporosis and conditions too numerous to list here.  Mothers ask about their children, middle-agers ask about their parents, and many other issues.  Other important health care topics are often briefly addressed , without any cost to the health care system,  which the administrators cannot even begin to perceive, because it does not fit in to the 'Health Care Industry' model, that they are understand.

               I am  afraid that medicine is going to do as well under the direction of the health care administridiots as finance would do under the direction of physicians!     In any event, let's not eliminate  the foundation block  of communication in  modern medicine, the periodic complete history and physical examination.